Individual
RYAN CONWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
900 E 7TH ST, M005, BLOOMINGTON, IN 47405-3905
(812) 856-4468
Mailing address
817 S LINCOLN ST, BLOOMINGTON, IN 47401-4711
(314) 520-1176
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
01/30/2015
Last updated
01/30/2015
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